<?
$domain_name = $GLOBALS['domain_name'];
$info = $GLOBALS['info'];
//print_r($info);
?>
<br />
<table width="100%" border="0" cellspacing="0" cellpadding="0">
  <tr>
	<td align="left"><strong>Domain look-up, Registration or Transfer</strong></td>
	<td align="right"><a href="domain/faq.html?tab=mail_cluster" target="_blank">Help/ F.A.Q.</a></td>
	<td align="right"><a href="domain/faq.html?tab=tutorials" target="_blank">Tutorials</a></td>
  </tr>
</table>
<table class="reg_table" width="100%" border="0" cellspacing="0" cellpadding="0">
  <tr>
	<td>&nbsp;</td>
	<td>&nbsp;</td>
	<td>&nbsp;</td>
	<td>&nbsp;</td>
	<td>&nbsp;</td>
	<td>&nbsp;</td>
	<td align="center"><img src="domain/images/ico_step_4_4.gif" alt="Step 4"></td>
	<td>&nbsp;</td>
	<td>&nbsp;</td>
	<td>&nbsp;</td>
  </tr>
  <tr>
	<td align="center"><img src="domain/images/ico_completed_step.gif" alt="Step Completed" width="37" height="36"></td>
	<td align="left">Search</td>
	<td align="center"><img src="domain/images/ico_completed_step.gif" alt="Step Completed" width="37" height="36"></td>
	<td align="left">Set Purpose</td>
	<td align="center"><img src="domain/images/ico_completed_step.gif" alt="Step Completed" width="37" height="36"></td>
	<td align="left">Mailbox</td>
	<td align="center"><img src="domain/images/ico_current_step.gif" alt="Current Step" width="37" height="36"></td>
	<td align="left">Whois</td>
	<td align="center"><img src="domain/images/ico_next_step.gif" alt="Next Step" width="37" height="36"></td>
	<td align="left">Payment</td>
  </tr>
</table>
<br /><br />
<div style="background-color:#DCDCDC;padding-top:3px;padding-bottom:3px;padding-left:10px;">&nbsp;&nbsp;<strong><strong class="red">STEP 4</strong>: Submit Whois Contacts</strong></div>
<p>This information will be used for Administrative, Technical and Registrant contacts for <strong><? echo $domain_name; ?></strong>.</p>
<p>Later, after the verification of your order and the registration of <strong><? echo $domain_name; ?></strong>, you will be able to edit the Whois information for each of the above-mentioned contacts.</p>
<p align="center"><strong>REGISTRANT INFORMATION:</strong></p>
<form name=sform id=sform onSubmit='return false;'>
	<table align="center" width="100%" border="0" cellspacing="0" cellpadding="0">
		  <tr>
			<td align="right">First Name:</td>
			<td><input type="text" name="info[first_name]" id="info[first_name]" size="35" <? if($info['first_name']){echo "value='$info[first_name]'";} ?>></td>
		  </tr>
		  <tr>
			<td align="right">Last Name:</td>
			<td><input type="text" name="info[last_name]" id="info[last_name]" size="35" <? if($info['last_name']){echo "value='$info[last_name]'";} ?>></td>
		  </tr>
		  <tr>
			<td align="right">Organization Name:</td>
			<td><input type="text" name="info[company]" id="info[company]" size="35" <? if($info['company']){echo "value='$info[company]'";} ?>></td>
		  </tr>
		  <tr>
			<td align="right">Job Title:</td>
			<td><input type="text" name="info[job_title]" id="info[job_title]" size="35" <? if($info['job_title']){echo "value='$info[job_title]'";} ?>></td>
		  </tr>
		  <tr>
			<td align="right">E-Mail:</td>
			<td><input type="text" name="info[email]" id="info[email]" size="35" <? if($info['email']){echo "value='$info[email]'";} ?>></td>
		  </tr>
		  <tr>
			<td align="right">Address:</td>
			<td><input type="text" name="info[address1]" id="info[address1]" size="35" <? if($info['address1']){echo "value='$info[address1]'";} ?>></td>
		  </tr>
		  <tr>
			<td align="right">&nbsp;</td>
			<td><input type="text" name="info[address2]" id="info[address2]" size="35" <? if($info['address2']){echo "value='$info[address2]'";} ?>></td>
		  </tr>
		  <tr>
			<td align="right">City:</td>
			<td><input type="text" name="info[city]" id="info[city]" size="35" <? if($info['city']){echo "value='$info[city]'";} ?>></td>
		  </tr>
		  <tr>
			<td align="right">State/Province:</td>
			<td><input type="text" name="info[state]" id="info[state]" size="35" <? if($info['state']){echo "value='$info[state]'";} ?>></td>
		  </tr>
		  <tr>
			<td align="right">ZIP/Postal Code:</td>
			<td><input type="text" name="info[zip]" id="info[zip]" size="35" <? if($info['zip']){echo "value='$info[zip]'";} ?>></td>
		  </tr>
		  <tr>
			<td align="right">Country:</td>
			<td>
				<select style='width:230px;'name="info[country]" id="info[country]" title='select_country'>
					<?
						if($info[country]){
							echo get_countries($info[country]);
						}else{
							echo get_countries();
						}
					?>
				</select>
			</td>
		  </tr>
		  <tr>
			<td align="right">Phone:</td>
			<td><input type="text" name="info[phone]" id="info[phone]" size="35"  <? if($info['phone']){echo "value='$info[phone]'";} ?>></td>
		  </tr>
		</table>
	<br /><br />
	<p align="center"><input type="button" value="&laquo; Go Back" onClick="choosePlan(document.getElementById('params').value);">&nbsp;&nbsp;&nbsp;<input type="submit" value="NEXT &raquo; Select Payment Method" onClick="choosePM(fetchForm());">
	</p>
	<input type=hidden name=params id=params>
</form>
<br />